to discuss is and likely disagree about some of the questions, we are were excited and honored to have our distinguished panel. first of all, just in alphabetical order. jar red burn. from 2009 to 2011 he served as chief economist and economic adviser to the president. a member of president obama's economic team. prior to joining the obama administration he was a senior economist and director of the living standards program at the economic policy institute in washington. robert bix by has been with the coalition since 1992. and served as executive director since 1999.

serves a a chief staff attorney at court of appeal in virginia. the committee for responsible federal budget and member of the campaign to fix the debt committee. she served alongside bob as a member of the bipartisan policy the president of ceo of the center for american progress and counsel for american progress fund. she was one of the first here. we opened our door as serving as senior vice president for domestic policy. since then she has served as legislate i have director for senator clinton. presidential campaign and domestic policy director as president obama and campaign in 2008 and senior adviser for health reform at the department

of health and human services. david is the chief washington bureau at "the new york times" company. and writes the weekly economic scene column for the business section. se serves as staff writer for "the new york times" and magazine and contributes to the economist blog. in 2007 he was awarted the pulitzer prize for commentary. prior to joining the "times" in 1999 he worked for business week magazine and the post. i would like that welcome them to the stage and give them a warm welcome. [applause] >> thank you coming. we're not going to do opening statement. we're going talk for awhile up here and then have a libel of a

discussion and debate. and we'll open it up to you all and take some questions and conversation from the audience. so i guess i want to start out by throwing a question out there for neera. we should not worry about the deficit in the short term. it's not the most important problem and not about to bite in the short term. we should worry in the long-term. what i want to ask you is if we imagine a country which you got to be -- i could see -- [laughter] i could see -- >> that should be on my -- [inaudible] >> how we can do that. you would laid out all kinds of idea for reducing the deficit. and we would have some faith that you do that. the way the political system works it's hard to cut the deficit. i guess the question i would

have is given the kale of the long-term challenges we have, right, i given the fact the nor we wait and the more they buildup and the smaller part of the population. isn't it dangerous to say more chocolate today more spinach tomorrow? >> so i think what is interesting about the debate in washington we have been excellent at the spinach. i would turn it on the head. if yo look at policy making over the last several years, we've been -- we've excelled at deficit reduction. not in ways that is the most rash rash tell me. we made progress in the deficit reconstruction. we haven't been making progress in term of policy making in economic growth, reducing unemployment, andth. what is fascinating about the discussion in washington is, you

know, the traditional notion that deficit reduction is so hard and investment is so easy has been turned upside down. and, you know, i think that there's a common view that deficit reduction all day gets harder -- always gets harder, you know, the longer you put off. what we're saying, you know, obviously we have put a lot of plans we believe are the right plans for long-term deficit reduction. we are just in a -- we are acknowledging that we're in a political climate in which deficit reduction seems very difficult because of the constraint of one, you know, one party to the talks that will come. you know, we're dealing with a world in which it's the position of one political party. and so we saying we should not

hold hostage investment in the economy that are desperately needed to a search for a grand bargain that may be good in the abstract which is heard from actually acting right now. >> i think that not doing deficit reduction right now is not accurately described as chocolate. [laughter] doing it later is not really span spinach. what i would argue is basically three quick points. first of all, i wholly agree with neera's assessment. and in fact deficit reduction, so far, if you include interest savings to $2.8 trillion over the number. and in at that fact it would take $900 billion over the next decade to stabilize it as a

share of gdp. i think that's a goal we would agree upon in the long-term. in a functional congress, which we don't have. it's actually not that heavy of a lift. so i i thought neera's teeing up of the framing was right. look, to somehow suggest db it's not your agenda. it's way you ask the question. it would be sugar or chocolate to put off current deficit reduction is, i think the wrong frame. it's much after you have been nor nourished. our economy is suffering from absence of basic nutrition. and the austerity embedded in the deficit reduction, in my view, has come too quickly thus far is the -- i think that's something we on the panel agree on. second dpli, the reason why --

and in the long-term the reason it's not spinach once you achieve a more established growth rate. a bona fide recovery, again, we could recognize as a genuine recovery. not what we have now. the deficit relative to the economy falls on it own if you implement some of the kinds of changes that i think we need implement over the longer term. i'm not saying if you didn't do anything we would get better. i'm saying once we start growing again in earnist. the changes we need make are actually, i think, again not that heavy lift. finally, quick point, we -- the thing that drives the long-term -- neera mentioned question get in to that. and pressure for health care cost. we have made real progress in slowing the growth of health care costs. what we don't know yet how much

they're going stick. so we can -- we actually could and should take advantage of the savings about 900 billion according cbo it's the savings from slower growing health care cost over the next decade. we should take advantage of that so we don't rush in to i would say wrong headed austerity tsh what i think is hair on fire big emergency/the budget. we have time to be thoughtful. >> you said teasing real difference among the panel. i want to ask bob. so if i were to take a -- what do you do, sir? right. i think it's a version of health care cost are slow. we need deficit reduction over ten years. we got it over a combination of

tax increases pushed by obama and the republicans. you can score it in a different way. >>st they siewming sequester which it's there. we had a lot of deficit reduction. i guess the question i'll start with bob on the end is i think there are at love people say boy, it would be a big deal if people like the two of you people have your view on things came out and said right now the problem isn't the deficit. the bigger problem is the state of the economy and the is deficit is second. why not make that argument from your perspective? and push the deficit to second degree? >> well, i think we keep make the case on the grand bargain

side that the short term deficit is not the problem. and that what we need to do from a grand bargain point of view is attack the structure deficit, which is the long-term mismatch between spending program and revenues. and you need to put those things on the table. so i would agree that in the short term the deficit is coming down it's looking better. i don't see it as a reason to postpone trying to address that structure deficit, which i've always viewed as a real problem. i don't think the problem has been solved. the numbers are going switch every now and then. that looks a little bit better with the health care and the changes made. the health care costs coming down. i look at the good news and say look at the last cbo projection you had declining health care

cost, the debt looks relatively stable over the next ten years. we have the cap on discretionary spending. and yet we still have a outlook that is unsustainable. at least the debt begins to go up again toward the end of that period. so i think you can walk and chew gum taiment. -- at the same time. i think the only way you did get an agreement that might dot sort of long-term structure issues that sum of -- some of us want to get at combined with the short term help to the economy is through a grand bargain. i don't see being able to address them separately. >> let me start by saying i decided i would go on a min -- to see from the green juices kale and spinach juice for breakfast. i'm part of the eat your span

itch. i have spinach for breakfast. the kale drinks are not as gross as you would think. [laughter] >> they slip fruit in it. >> you think -- they are kind of tasty. we've heard that. so right little bit of sugar a long with the spanish. we have a solution. i think there's been real fiscal problem in the last couple of years. i think that's great news. i think we agree is primarily been not in the right way sort of a lot of changes that we've done through the discretionary cap which not the big problem area in the least. the sequester now -- the way reraise revenue not the best way to generate revenue. that's one thing i think we

would say so far the accomplishment on deficit reduction not actually the ones that we would want to have accomplish. the big part of the budget that still need to be addressed haven't been. i think we also agree that the problem is not solved. if you look at what the fiscal objective is. i would say you want to put the debt on the downward path. it's not going fatser than the economy. we stabilized it. it's coming down for a couple of years. then it's going come back up. we haven't reached overall metric. i think we would agree there's more to do. i think we would agree that austerity meaning significant deficit reduction not the right thing for the economy. i believe we believe that. we're not focusing on deficit reduction now. that's not the problem. the problem is in the future. the medium term and the long-term and might disagree is how important is it to start working on those medium and long-term issues right away. and i would say you don't --

need to cut the deficit. it may be coming down too quickly. you need make the decision as quickly as possible. continue to delay how are we going deal with the biggest problem with the economy health care cost. we've the good news it's growing faster with the economy. the perfect budget solution from where i stand. where from i stand there's no perfect budget solution. we need to work on the trend as requesticly as possible and not have two sides fighting for years and years and years i want this revenue package and this spending package and move toward the comprise piece.

you have said it would be a big deal deficit reduction. i'm sure bob got calls all the time. the truth was at the time. no. we weren't. i wasn't. that deficit was -- bay huge economic recession and the fact we need take real measure in term of deficit spending to deal with a that. there are times depending where you are on the business cycle and you want big deficit. and the word is coming out that's one of the reason the deficit was big and coming back down now. there's a structure deficit problem that we face in this country.

how we deal with the challenge and deal with the economy. >> neera? >> i want to kind of respond to a few point maya raised. and probably no particular order. on the issue of health care cost. it's the case even moderately higher than inflation. we are also at the 50-year low in term of the numbers that are coming in term of medical inflation. and so i think it's policy makers, you know, we shouldn't, you know, there are variable in both directions. we shouldn't assume that health care costs will stay at this level. the question that i think that i think we have to grapple it neither should we assume that they will automatically go back up.

they are variable on both sides. and, you know, for all we know. health care costs could come in lower. and so the idea of -- having said that. we proposed a lot of reform with the health care that address lowering, you know, trying to be aggressive. we are, you know, mindful that middle and low-income seniors have born a lot of burdens, and the last during the recession, middle and low-income people have born a lot of burden in the last few years. and placing greater burden on them is a big question for us. i think it raises to the second point i would like to make is

that we absolutely agree that an optimum situation is long-term deficit. like having a plan and we broadly agree maybe not in every fine point. that we should a long-term deficit reduction plan. that investment -- i think that washington has, you know, the obsession was deficit reduction. you know, we had have to acknowledge that we have some responsibility for the high unemployment we have right now. you know, poll in washington has not been focused on a laser beam. on economic growth. what the federal government can do. to address long-term unemployment. political actors on all sides have been much more focused if you look at the house of representatives, they very little talk about long-term

unemployment. economic growth measure that address the suffering people have right now. i guess the point we are making is the point i would like to make is that essentially, you know, we have some responsibility for it. and washington can do so many things. and try to get a grand bargain. it hasn't happened because the house of representatives has been intransigent on the issue of revenue. we are simply making a point you could have a small term deal that works over the next couple of years to, you know, substitute sequester. that has investment and address unemployment and infrastructure, other programs. these are idea we put out. and there's -- we shouldn't hold again and hold hostage doing anything around economic growth rate right for unfortunately has proved elusive.

>> in the interview, the president had with the "times" the last week around the weekend. he said he wants to move away from the damaging framework in washington on the deficit. the question for all of you -- >> austerity i think he used. >> austerity. >> yeah. >> [inaudible] >> to what extend does he deserve some blame for that? that would include the pivot, when the administration pivot in the first turn emphasizing stimthrows deficit. -- the white house county have to be in favor of letting it last this year. neither retrospect or saying they should have known at the time. does the president deserve some of the blame or credit for that framework he decries? >> that's exactly where i want to jump in. thank you for asking. i think the answer is probably some. i wanted to say, you know, for my -- i don't want to be unfair to

anybody, but there's almost too much agreement up here on this point. you know, the budget deficit, which i believe is about 10% of gdp in 2009, is going to be under 3% according to the forecast i have seen by 2015. so maybe everybody up here was alarmed about that and saying it's falling to quickly. it's not the way i think it was plaid -- played out in the real worlded. i think there have been strong forces pushing policy makers through deficit reduction too soon in my humble opinion. it sounds important -- i think we are assigned to the panel so there would be some disagreement. where is the displeement where do you think -- and i invite everybody here. what are the molls measures not

the framework and discussion you think? >> i would say the poll you want focus on the one that phase in slowly and compound the savings over time. not only are we focus on what kind of savings we get in the first ten years but the second ten years are important. something like the president put out recently. the improvement how we measure inflation is the kind of policy that we make at love sense for the current economy. it would have little savings like $2 billion in the first of the year. the growth of the savings becomes very large. the end of the decade and even larger. the same is true with health care measure or anything you do on helping to social security that you would phase in gradually. those are the kinds of policy that actually are the one that would get the main get challenges. but also, i think, fit with the economic situation light now. wouldn't do a lot in the short term or the long-term. i would think what you want to do is strayed out the more damaging cut from the sequester and replace some of those

mandatory savings. >> [inaudible conversations] >> that's forward-looking. how did that happen? i believe i wasn't part of the problem. i was arguing strenuously against that including in the administration. was the president part of the problem? certainly the pivot in 2010 came too soon. but. >> let me put it. one of the reasons why we did the work we did to point out the changing we have to acknowledge there was an over arching chorus of voices that many organizations were part of that.

pushed for massive deficit reduction. the theory was that the deficit picture was 8 percent of gdp. it was a concern. people heard i think in policy makers adopted that strategy; right. because they heard the voices. they didn't apparently hear any of the voices about very little immediate action reduce the deficit to invest in the economy now. they did very little on that. i guess what we're trying to say is the reality has changed. if you look at the ledger from 2010 where there were projection of deficit reduction and economic growth. deficit reduction we are doing better than we thought we would. economic growth we are doing worse than we thought we would. cbo's projection we would be at 6% unemployment. we are at 7 and a serve and a half. let's come, i mean, short term

investment and economic growth let's have idea on that aggressively right now. the deficit picture hasn't changed. we talk about chained cpi we're the idea around getting investment and growth now that will address the suffering people have now for long-term unemployment. >> i was going to say a lot of short term decrease in the deficit has come from the economy recovering. simply because of policy changes that took a meat cleaver to the budget. the some of the automatic stabilizers have, you know, reversed course. that's a good thing nap sort ever deficit reduction was going take place. it wasn't the result of policy changes. i would agree that some of the, you know, sequestration that has taken place in the last year is not good policy.

it's not hugely responsible for the short term decline in the deficit. it's, you know, part of a a longer term. so -- and so we did have the payroll tax cut expire and the tax cut go up on upper income people. that's contributed somewhat to the smaller deficit. i don't think the sudden drop in the deficit is a as a as a result of -- solely the result of some relentless drive to, you know, put on the cut spending. >> do you think -- the question whether the deficit we haven't done -- whether we have done enough work in the long-term. i think all would agree we have not. do you think the deficit has come down too quickly in the short term? do you think it should be higher than it is today? >> not necessarily. it's still around 4% of gdp. i think that, you know, it's normalizing as the economy

continues to recover. the question is do you continue with policy like sequester that maya said hit the wrong part of the budget. hit the thing that the investment. if you make investment they come from the program. it's going to be increasingly difficult to do that. it's not the good thing policy wise. jawing -- adjusting the sequester i think is a good thing. >> whey hear them saying is a version of, look, the deficit has come down a lot. it's come down more than we forecast. economic growth is slower than we forecast and the unemployment were at least employment population ratio is worse than we thought. and the decline of the deficit has caused some of that. i'm interested in if you agree with that. do you agree with an idea we've had an economically damaging amount of austerity over the last two years. setting aside the long-term question. or the right amount of short term deficit reduction so far? >> honestly nobody ever knows --

absolutely. >> nobody knows what would have happened otherwise. if you look at the numbers where the deficit reduction has come. i think part is bob said it. it's come from the economy. ing better than we thought it would. the economy is not on track. not what it should be. there's a lot of policy that you need to be dealing with. i would say one is switching out the wrong kind of deaf dit reduction for the right kind. i think the scwes leer have a bite on the economy going forward. people paying selling in their stock because they knew the tax rates will go up. ..

>> we are not doing very well on those three at 4:00 a.m. to be doing better for private investment there is all economic growth that

we have to be a part of. >> i quite strongly disagree but we can look into that. [laughter] did think it is a product of too much cable television but but they know this stuff very well and have been working in this field for a long time but on the near-term economy and take you have that backwards. to say the economy has done better than we expected but in fact, every forecaster had to we marked down because the economy continues to do worse than expected year-over-year growth is barely 2% i guess

we don't have second quarter yet but it comes in and around 1%. >> so that is the second part that is not a function of the faster growing economy. and somebody should know how much but in my first comment i talked about 2.8 trillion of deficit spending. maybe the tax increase bill that they would talk about but any way with the payroll tax holiday we have had

significant economic policy economic growth is deeply subpar to say i am okay with that if the economy is okay seems to be missing a lot of pain that is going on out there. >> 1.he made long term if the debt to gdp ratio is out of black that will have a good balance for economic growth we can disagree but i guess what i find frustrating if we have been economic growth spurt then dole holds austerity debate that we are focused on the monster program which i agree but we don't have a rational political actors

but at the same time it is very frustrating of those challenges to that growth in real challenges right now. >> is appointed a half from the growth issue. >> i know but to basically say building it big enough follette once in your report points out the grand bargain come i think that is read a wish we could put in place that would bring confidence but i don't think they can come up with that. that their proposal to offset the portion of that is three-quarters of it would be from revenue and whether or not it is policy will not have been either so

what could we possibly get done richet try to work on these issues? think about politically what can get done but it may not have a chance going forward. >> let me talk about what is the record to have exactly 50% revenue? in the do count that's that should have been the sequester the meeting but we are saying is when they talk about a couple of hundred dollars that seems much more reasonable of full-size in

the revenue could make up for that. so as to do that damage for a period of time that are really hurting people right now the cbo does project 700,000 invested that is a lot for sequester and i think with the house of representatives to do $100 billion of revenue. and those are circulating around the hill right now. >> you both talk about the forces that created this deficit. could you put some meat on

backbone and whether the political groups that blame the media? [laughter] that is probably true with the lawyers. >> what has created this framework? >> can i start? these are the fax in they will work when they started with deficit reduction and, etc. but to think where we would be we are far worse. it was very reasonable for actors to say this is a significant challenge. we're not arguing there is

the crazy alliance of people all of our planet is that right now the world has changed with the policy makers throughout the spectrum in the issue is what forces are people right now? >> i don't totally agree and they are absolutely right with the cbo projections with the 10 your budget forecast. but in the near-term and i

was there working to the administration not that it was too large but is it big enough to offset the magnitude? of the contraction? i think these forces are those that are less interested in deficit reduction step there are more people who want to shrink the had bad of government. they don't like the safety net but in order to roquette medicare cost, they attacked him for that. when you write down the numbers i think it is the

tea party the republicans' small government overall of what that actually means for the long term as that is the ideology but i will say they have contributed to the near term reduction it is quite different so perhaps it is a communication saying. >> so what you are saying it contributed to the over emphasis? >> our focus is on the medium and long-term. >> that is what i meant for

example, everytime they reduce the deficit i hear it does not go far enough. including the president's speech the other day but i say the criticism was the wrist the president addressed so i stand by my assertion every time they do the debt reduction but they do it in the medium term so it makes sense to me. >> it is the only message that comes out we need to

take care of the deficit and that has more of an impact. >> it is difficult sometimes between the long-term and short-term and they don't necessarily look at short-term or long-term so i do think that is part of discussing the whole issue. and with those that are more interested in the sustainable fiscal policy or shrink the government. i want to get back to what degree do about it? that is part of what is going on with the president's tour not so much

as a resetting but when warfare to another for the proposal is put out. people are talking past each other and not with each other. if we want to have this discussion economic growth growth, let's say that my it and i said things have changed so let's talk about growth. let's all so talk about the structural deficit. i thank you can do both in you have to and what we're missing is some sort of process we can have trench warfare over the medium or the short term and a regular

order of the budget the budget made proposals there is not a mechanism now to make that trade off to say maybe we should accept higher spending on things that have a high potential. in the short term. >> it's not about setting a profit or that the obama and john bay near like each other but i think what they would argue is that one has gone much further from the center than the of their party and those of us that tried not to pick a side have a really hard time with that.

that barack obama will cut medicare and social security but republicans will not raise taxes. >> that is a problem. [laughter] but on the other hand, there is the possibility you have some and i would like to see something going on there was the budget negotiation because everybody recognizes that some point they have to be a part of the solution. >> to be in a terrible place it is toxic and very difficult but i do think

what we have done so far we cut discretionary and raise revenue what we have not done is with medicare we have not done entitlement reform. so for that to be balanced but they would say we have done everything that we have it done with in taliban. when the the reasons we have medicare is because we are reforming medicare. but the deficit reduction with the health care reform

so the affordable care act itself was a deficit reject -- reduction strategy. >> especially the long term. >> but what we talk about one of the challenges that in your concern from overall that it does the framework much to the chagrin of his allies met by the house republicans with the paul ryan budget and also with simpson-bowles to have revenue and spending cuts

but what we have seen where it matters for us is to go farther and farther away that those advocates. >> even with the year and stuff? with the fight over the high end tax rate bill clinton won? >> 82% of the bush tax cuts were locked. >> i am talking of hiring. >> i don't know if you were suggesting this but i don't think we're anywhere near done and for example, i have been stressing already with

interest savings the policy part of that is in spending it may not be optimal. i like 50/50 and certainly this gets to your question i am not sure in the president's budget is put forth 400 billion in medicare and medicaid. so i think that sounds accurate. >> i agree. but they should not be all pushing the of budget.

>> is a very sensible offer. >> they were looking. >> but they use the bully pulpit to rally public support there is a good budget proposal out there. >> i think that would be with where the general public and not know they want to hear the president even if it is long-term down the road i get back we said some other way but those that should hear from the president can do something about an economic recession.

>> i think we can feel the pain on that and talk about the budget proposal because. >> what does it matter? here is my budget proposal to the point they're reasonable voices in the senate it is hard to get the minority with the house republicans in the question is have you break out of it? >> with pushing the budget to talk about the need for a

better deal for the bequest my point is if they involve the engagement with republicans with the chance of getting something done it resonates with the public because if we just reset into the different trenches they will not be receptive to the president's speech but if it is big dollars mendez the issues that they had to i think there would be more. >> a lot if you are saying help me figure this out.

that 82 or three year deal with everything that would manifest itself. >> ag said they reduce something. >> but i don't think we should landline crisis to another. >> then how do you get out of the trench? >> the political trenches? >> i think he used the metaphor the new revenue has to be a part of it. but there would not be any

new revenue that i don't see how you're not stuck in the trenches. you're different because of the ticking time bomb? >> he made a speech saying he understood ended with the fiscal cliff was a terribly botched moment where we could have done so much better with lower returns savings put in place in real savings in the kind that is right with the budget but to talk about revenue it is real structure and reform and comes with tax reform or tax rates so how that would

have been better. >> what is fascinating with the discourse of what we went through and also with the entitlement reform had to go forward with those ideas with medicare, etc. but it is not that

republicans want in tide of reform let's not gloss over their the beneficiaries of medicare. that is the thing because of what we have had people ages about losing the benefits even if they have benefited from it and the challenge with the medicare debate they think is frustrating is so little of that today addresses the fact that things have fundamentally altered but yet we continue to have the conversation that this is the same as it was five years ago at a much higher level when the assumptions go for word --

go for word even more but then make those changes permit it even though we don't know that. >> it would be more helpful for this discussion it that focused versus the republicans giving their point of view because in washington is terrible we cannot get anything done. but that would be part of the discussion i think that the point is democratic way or the republican way or a compromise there is a legitimate concern from

every independent entity. but also in what do you do with these challenges and it is not clear that we can set to come up with a clear solution but washington is broken. >> the second point is the fact is that things have changed to be around the economic crisis we are concerned of those given by the health care cost. so then it skyrocketed because of the great recession of was a word about the recession was right about the depression but then then it comes back

down and the structural problems so i conclude about the same problems that were there before but in terms of the health care if the cost is coming down the bad news it is growing faster than the economies we have to think about ways to generate health care to monitor what is working and what is not. and they are implementing five or 6 percent. . .

not like all of a sudden a bunch of 80-year-olds showed up here. >> since 1946. >> and so i would say, what i would argue actually is that the facts we're having somewhere between 500 -- at least $500 billion change in health care expenditures by the federal government as predicted by cbo, because of the issues. might be a higher number. but as a product of medical

inflation, that is a structural thing. what is happening in medicare is a structural -- has a huge profound impact going forward, dwarfs what we do on raising the age. the criticism i have on proposals like raising the medicare age, is that -- entirely unproductive. raises the national healthcare costs. lowers cost to the federal government, raising costs for employers and individuals. so as a policy matter of supporting that kind of cost shifting, makes very little sense. i think the big issue, the big concern i have about this construct, is that if we have learn anything in the last few years, it's that the political forces are currently aligned in

washington are not going to take medicare savings or social security and invest them. the thing we have done over the last couple of years is kill al the investments that mattered like education, research and insvelte in order to preserve tax cuts. so if i could come up with a magical world in which we had a rational budget, i would make a whole variety of different outcomes. but i think this construct is so far removed from the political world you and i live in, it doesn't even make sense as an option. >> more optimistic, i think. by the way, as i recall the numbers -- someone should check -- i think the cbo forecast over the next ten years for medicare and medicaid together has come down by 900 billion over the past six months. from earlier. is that about right?

>> 500 over the last -- [inaudible] >> okay. it's a big number. hundreds of billions. paul vanderwater has done a lot of writing on this. my answer to your question is, i think with some relative -- some quite minor changes to social security it could achieve fiscal solvency over the 75 year forecast, and with medicare, i largely agree with neera, and i do think -- where we disagree, it has undergone a structural change. i hope it has. we can't be sure yet. but a lot of people who look at this very carefully, who understand the granular level of health care delivery, think it has. i think there are structural changes -- is a understand it, the thing that drives this is

called the excess cost burden, the rate at which healthcare spending is faster than gdp. think that's been around zero for the past couple of years. so that's a big structural change, if it's structural. in terms of the changed cpi, i think that if you -- this is often talked about in terms of entitlement reform. i don't see it that way. if you wanted a more accurate price index for elderly people, indexes are more accurate. you should do a chained elderly cpi. that is my first comment. secondly, if you're going to inject chain cpi into it, it has to be in the content of getting a whole lot for it. it has to apply to the tax practices as well and include protections for low-income people whose benefits are disproportionately cut, and should include significant new

revenues. that's the only way i would consider a deal like that. >> if we have a microphone. >> just took the politics out of it you both would say we do need to do more deficit reduction, make changes to social security and medicare, and my question is, would you say it would be smarter to make the changes now rather than waiting? >> not with this congress. you said take the politics out. >> take the politics out. >> that's hard. >> does it make more sense to -- >> [overlapping speakers] >> my view is that those are very important goals and that we should have them, but where we may disagree is i think the first, second, third priority for washington policymake series be what to do about economic growth. that's the point i'd make about political resources. there's only so much anyone can

make. the discussion we're having on long-term deficit reduction, i would rather not -- i would love to have a set of policies that actually -- hire back some of the teachers who have been fired at the state and local level. that's counterproductive on so many levels. make investment in infrastructure right now because that makes sense. >> if you were doing one big passage, you would include putting these things in now rather than waiting. >> here's what i think neera would do. [laughter] >> she would -- you can wave the magic wand, politics out of the window. there's only so much political oxygen. i put you two in a room, michael linden, dean baker, very people with different views who share -- and some conservatives. that's right. some conservatives, and say that

what you came out with is what we would do. so that it wouldn't absorb the political oxygen we need and we have a back-loaded plan that was balanced. there are enough people in town that would go there. >> let's go out here. ma'am, on the aisle. >> go ahead. >> my name is rochelle freedman with the coalition of human need, and earlier neera mentioned the pain out there. we have been documenting since march 1 the pain to low income families who are losing head start, losing housing, and all of those things. at the same time there's a vast growing deep inequality in our country, and then on top of that you have the unemployment situation. thus far, i don't think corporations have contributed one penny to deficit reduction. so i would ask bob and miya, do

you support tax policy changes that result in corporations, many of the wealthiest whom have paid zero taxes over a number of years, do you support policies that would make wealthy corporations contribute more to deficit reduction and what -- if so, what tax policy changes for corporations would you support? >> good question. thank you. >> go ahead. >> i'll answer that question first. i think that your opinion -- your starting point about the problem is absolutely correct. i look at your coalition and the fact that the sequester -- the sequester is going to do real damage. it's already started to and that damage is only going to get worse, and that's because we have been focusing on the wrong fixes and we need to look at the

real problem part of the budget. you desperately need to reform the tax code, both individual and corporate. what that means is looking at the over$1.3 trillion in tax breaks in lost revenue from deductions and exemptions and exclusions, even individual and corporate side. you need to reform them, get rid of the ones that aren't working, as much as possible, and use that as a basis for tax reform, which has to contribute to raising revenues along with doing the rest of the budgetary savings as necessary. i think that the overall goal honestly should be to think about how you make the tax code more progressive. i would do it in a way that is least damaging to the economy. probably do that at the individual level more than the corporate level because of the competitiveness issue. but the overall point is a really important one. tax reform is criticalful right now the differences in how

different industries are treated, corporations are treated, it's highly uncompetitive and highly not fair, and the same thing applies on the individual side as well where you have a lot of tax breaks. >> on the corporate side you favor revenue-neutral? >> if i was the white house i would support revenue neutral tax reform. >> i'm happy to raise -- [overlapping speakers] >> i think we're going -- i mean, because of the aging population and even as healthcare costs are -- the cost growth, we're going to have a problem because there are more people like me who are getting older and will soon qualify for benefits. so, that is what is really driving up the spending over the longer term. and as that -- as we go from a set point of federal spending at a sirred leverage 21% of gdp to a higher level, we need more

revenues, and so i agree with miya on the tax reform. most of the proposals from bipartisan groups, like d simpson and bowles, followed the principle you should get rid of exemptions and credits and deductions and loopholes that both individuals and corporations benefit from, and you can actually lower the rate if you wanted to and still get more revenue in, or dial up rates that you need, whatever you need to make it all work. so, i don't actually think that revenue -- i don't think that tax reform should be revenue-neutral. >> i think this is correct, i think 10% of the 1.3 trillion tax expenditures we forego it from the corporate tax.

>> man on the aisle. >> it's a concern that people raise. >> thank you. i'm going to direct my question initially to bob. first, i want to preface it by saying as a trivia question for all of you, or maybe those in the audience, what country in the world has the most billionaires? the united states. i personally am tired of hearing these talking points. so i think jarred sort of insulted people in the midwest and other parts who don't live in d.c., they're not aware and they're not engaged. i find that insulting. we don't care -- >> let me -- ask a question. >> my question for bob, was involved with the concourse coalition when i was in seattle. i wish you were out there more now. my question to you -- because the discussion today is about fixing the debt. what would the concord coalition

recommend today, do you -- would you want to look at changing the entitlements? having worked in health care, and knowing what is going on with the affordable care act, being one of those seniors now on medicare, and how it is not working, what would the concord coalition recommend today in terms of knowing that the politics in d.c. are broken, in terms of policy. >> what do you think the right solution on medicare is? [inaudible] >> just on medicare? [inaudible] >> i think that we're going to have to do a number of things, and i think that -- first of all, i would move away from the fee for service as much as we can. because that's a cost driver and drives a lot of waste.

rewards quantity rather than quality. and so there are some things in the affordable care act that would move in that direction. i think they could be more aggressive. if i was to design a medicare plan it would probably look kind of like the disvinci rivlin plan. we moved to a premium support type of system. which cap tated, put some sort of a cap on medicare cost growth, but would enact some underlying cost savings that would allow you to maintain within that cap, and i think that getting an ending fee for service would be one of them. i do think that beneficiaries can pay more, particularly the upper end. so phasing in a more means set of premiums, as we're doing, is another route. that does to some extent ask

people to pay more, there's no doubt. but that has to be part of the solution. so, those are a couple of big ideas on medicare. >> i want to quickly respond. i think this discourse is significantly damaged when you interject a level of rudeness that it thought your question did. [applause] >> and i was careful not say anything like what you said i said so let's also be careful about what. what i said, and i remember, i believe it would be cognitively dissident if the president went out, said aim here to talk about the economy and began by talking about the budget. so i urge you to listen more carefully. >> sir? [inaudible] >> thank you. larry, checker communications and a concerned citizen. one of the structural problems i see is that all jobs are not created equal, and if we're talking about growth here, it

seems to me that if we believe -- i think we do. tell me imi've wrong. this is a consumer economy. so, if two-thirds of our economy are based on consumer consumption, you have so many people out there right now working two and three jobs and still can't make it, it seems that's where the structural problem lies, and this is at a time when corporations are sitting on trillions of dollars, banks are making unheard of profits, executive pay increases are going up 14%, while most workers' salaries remain flat. they claim that nearly half of all americans don't pay taxes. they can't afford to pay taxes. how do we get -- i guess my question is, how do we get those at the upper end, those in the corporation separate structures, in the 1%, 10, even 20%, how do we get them to understand we're install this together and if we don't break this log jam this country is in deep, deep, doo-doo.

>> can i take this one? i think the president was talking bat lot of these trends, and one of -- in his remarks in the "new york times" over the weekend, and i think you're absolutely right. one of the great frustrations that we have is that people tend don't recognize enough how much growing inequality hurts economic growth over the long term, and we have done fair amount of work on this, and there's a whole range of reasons why that is true. one of the one you referenced, a 70% demand economy. so when people have wages, they have income come in, they're able to buy things that's correct really important. so much of it is fueled by consumption, and one of the big challenges in this economy is precisely this issue, which is that the wages have been stuck. there's a lot of downward, technology, globalize.

>> other factors, that is creating real pressures downward, and one of the reasons why economic growth has been so anemic. so getting at the kind of issue that was the spray -- the downward growth for the country is almost completely absent from the discourse in washington. because for a lot of reasons, process reasons, we're so fixed on the issues of the fiscal cliff, and previous points we had, real challenges with deficit reduction. so i say, again, what your pointing out is really the political economy question we have, which is in a world in which we live today, how can we get focused on some of these challenges that are not ten-year problems, 15-year problems. they will get much worse in ten

or 15 years, but they're really big problems today, and that's part of the work we're trying to do. >> i love the question. i think it goes to the heart of the challenge. it's not a political economy question. it's a economy question. there are huge challenges facing the u.s. economy and the global economy but the u.s. economy in terms of growing nick inequality quote, know how to grow the economy, the fact that competitiveness is not what it should be. the fact we're not trained -- we do not have enough workers trained to be able to actually function in this economy, and these are terrible threats not just to the people who are suffering but to the overall economy and we need to seat more wholisticly. one of the things that frustrates me as more -- on my think tank side, i haven't seen a whole lot of new ideas which are really how we're going to deal with these in the globalized type of competitive, hyper integrated economy, and i'm hoping the issue is so deep and profound that people start to understand how it has such a

ripple effect to the economy that some of the great minds will start moving in this direction, come up with new ideas. what concerns me is leaving the fiscal piece out of that discussion. the economy is an integrateed mechanism, and we need to think about growth and inequality and fiscal sustainability, and we are very compartmentalized on capitol hill and also think tanks. one of the problems i see as a result of the excessive borrowing we have done for so long, our debt levels are now at historic highs, other than post war periods, and it leaves us strapped when we're thinking about the kind of investments we need to be making in our economy. so we now need to think about the -- the budget is a tradeoff. we're putting a whole lot of money to certain parts of our budget and our economy, and we are neglecting others, and i think they sequester and the need to fix our entitlement programs is one 0 example of

that. but what we're willing to cut investment programs because it's easy, to just put cap on discretionary and don't look at the programs and talk about the real effects and not willing to deal with the bigger challenges in healthcare entitlement because they're hard and people push back. i home we can kind of use the need to deal with our long-term budget to the rethink the -- we're sacrificing the kind of investment and concerns on the economy that really need to de. >> in the spirit of disagreement, let me say one thing. when we talked about -- there's -- everybody has supported things like changing medicare benefits for high end. things we were talking about was the discourse in washington about into it. ments -- about entitlements has been hitting middle and low income people who receive these

entitlements. we shouldn't think this conversation is divorced from the conversation about inequality. it's true, it's for older -- >> but supporting efforts to take funds from middle income and some low-income by-by-riz, whether they're medicare or social security recipients, would exacerbate inequality as well. now, we can all say there are people more deserving of investment, like the horrific numbers of poor children we have in our society. but we should also recognize, this the absence of making a huge investment there you're still talking about deficit reduction often does drive inequality. >> it doesn't have to, but given -- >> but it has. >> it has. sir. >> i'm a legislative education consultant. i used to be connected with a group called the cf foundation

in arkansas, which believes in the infusion of the arts and education at all levels. and the lady on my left, your name is -- >> miya. >> i'm glad your kind of blending into my thinking in this question. seeing as how there's a group of people in congress -- nod nod, winkles, hint hint, who are taking all revenue increased off the table before any conversation begins. does the group think that we have invested enough in education to satisfy our hyper connected economy and its work force down the road? or not? >> well, i defer to the group. i would guess none of you think we have invested enough but there's a serious argument we have and we're doing until the wrong way. >> you think we have invested enough? >> i don't think there's -- i think you put your finger on the right question, which is

really -- not like an amount. it's whether it's being properly targeted or not. i'd be perfectly happy to spend more on education. but if it's for loans that subsidize schools that just charge more for -- to build sports arenas, that's not the way to do it. so i'm not sure that i would -- early childhood -- >> i think that's an investment. the sort of thing we should be investing in. >> does remind me of the one thing the government doesn't do well enough yet, we're starting to collect a whole lot of data on the performance of various program us but nothing doing a good job of integrating it into our budget, and if we were able to take better use of the data we're starting to collect, and this is likely to happen with the fiscal pressure -- we'll do more than cost benefit analysis and look at what is outdated,

but if we were able to do that it would be so incredibly useful to point out the places and my guess is that we are misspending education resources and we need to be spending a lot more on education and public investments, but i hope we'll integrate much better use of metrics and data into our budgetary process because part of the problem with reforming the budget or raising revenues, you shift money not being spent well and people say i don't want to give anymore money to washington. we need to make sure we spend the money intel are able to validate where we spend money, and the public investment sector. >> another way to say that -- let me turn to you guys -- as popular month experts as early childhood education is and as high as its overall returns seem to be, probably also spending a lot of money on low-quality early childhood education. >> i'm not sure. certainly some. by the way, david is being

humble but he wrote a very useful ebook, guess you call it, book you can't get on paper -- >> you can print it. >> and it's -- much more efficient. >> great chapter on precisely this question on education and our programs. so i commend it to you. look, of you were to look at almost any realistic budget projection, the part of the budget that contributes to what you're talking about is going down, and it's going down quite quickly, as share of gdp. as a share of gdp, once you take out net interest and entitlements, all the other programs are supposed to fall by about 4% of gdp between now and 2040 according to our projections. that's a lot. now, given my colleagues' comments i'm not suggesting every dollar we're currently spending is well spent, but i think a lot more are than you might suggest weapon don't have

time to get into this but if you look at my web site, my blog, and you sort of search around -- i've written numerous articles about the president's proposal for early childhood, and within there i look to a lot of people who speak to david's question, which is, well, how much are we wasting on some poverty -- things like head start that aren't as efficacious as it should be, and the answer is, it's not cut and dry. there are head start initiatives based on long-term cost benefit analysises are doing a good job and some that aren't. i agree we neat to separate the wheat from the chaff, but i think we're doing some good stuff and at risk of doing less. >> let's all get together again in five years after we have solved all our problems. thank you all. [applause]

[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]

>> keeps me up at night is that if i'm asked to deploy 20,000 soldiers somewhere, i'm not sure i can guarantee they're trained to the level i think they should be over the next two or three years because of the way sequestration is being enacted and that's really a concern. that means that, yes, we'll still send soldiers. yes, we'll be able to train them to a lower level and they'll be individually ready but will not have been able to train collectively. that means operations would take longer, but most importantly, it probably equals more casualties, and that's the concern. so, ion i said let's do sequestration, it should have been written differently which gave us time execute it probably, where we can do it in a back year.

complete it by this year and let us get there in the right way so we're not taking so much risk this year, next year, and the year after, which is the case right now. the other comment i would make, i do worry about the size of the cuts, and for us, we have to -- in order to keep it balanced -- one thing the secretary of the army and i have been very clear, we're not just going to keep an army to keep an army. it has to be ready and modernized so we have to continue to reduce the size of the army, and i believe potentially we're going to be caused to get to such a point with the size that we're going to have to completely relook our strategy and relook how we think we can use the army in the future. those would be continued discussions we have to have as we move forward. >> in a few moments, senator john mccain eulogizes retired colonel george bud day in 15 minutes, a discussion about the new healthcare law and how it's

being implemented. then a hearing on the fccs upcoming spectrum auction.

>> retired colonel george bud day was a medal of honor winner and was john mccain's cellmate. the arizona senator spoke for ten minutes. >> sunday, brought the sad news that my dear friend, colonel george "bud" day passed away. he was 88 years old. to say he lived a full life would be quite an understatement. his was filled with so many extraordinary experiences, adventures, challenges, accomplishments, and with such love, compassion and courage, that it could have supplied enough experiences, excitement and satisfaction for ten lifetimes. bud knew due feets and triumphs on a scale few will ever know. he lived in moments filled with every conceivable emotion. he knew terror and suffering.

he knew joy and deliverance. he knew solidarity, self-respect, and dignity. knowing him as well as i did, i'm certain he faced his end, satisfied he had made the most of his time on earth. he will have faced it with courage as he faced all adversity. he will have faced it with gratitude for the love and companionship of his beloved wife and best friend doctorie, his son, stevey and george, and his twin girls, sandra and sonya, he would have faced it with humility for having had the honor to serve his country with distinction in three wars, world war 2, the korean war, and the vietnam war. i had the honor of being bud's friend for almost five decades of his 88 years. we met in 1967, when the vietnamese left me to die in the prison cell bud shared with major norris overly.

but bud and norris wouldn't let me die. they bathed me, fed me, nursed me, encouraged me, and ordered me back to life. norris did much of the work. but buddied all he could, considering that he, too had recently been near death. shot, bombed, beaten savagely by his can'tors, and his arm broken in three places. he was a hard man to kill, and he expected the same from his sub bored -- subordinates. they saved my life. a big debt to repay. but more than that bud showed me how to save my self-respect and my honor, and that a debt i can never remay. bud was fierce, and i mean really fierce, resistor. he could not be broken in spirit. no matter how broken he was in body. those who knew bud after the war could see how tough he was. bit, my god, to have known him

in prison, confronting our enemies day in and day out, never, ever yielding, defying men who had the power of life and death over us, to witness him sing the national anthem in response to having a rifle pointed at his face, well, that was something to behold. unforgettable. no one had more guts than bud, or greater determination to do his duty and then some. to keep faith with his country and comrades, whatever the cost. bud was my commanding officer, but, more, he was my inspiration. as he was for all the men who were privileged to serve under him. nothing offers more compelling testimony to bud's guts and determination and his patriotism than the account of his escape from captivity. in the entire war, he was the

only american who managed to escape from north vietnam. in 1967, then major bud day commanded a squadron of f-100s that served as forward air control over north vietnam and laos. they were called the misties, named for bud's favorite song. theirs was probably the most dangerous combat duty in the air force and suffered high casualties. on august 26th, build day was one of those casualties. bud was shot done 20 miles inside north vietnam. he hit the fuselage when he ejected, breaking his arm, damaging his eye and injuring his back. he was immediately captured by north vietnamese militia and was interrogated by his captors in an underground prison camp. when he refused to answer their questions they staged a mock execution, then hung him by his

feet for hours and beat him. believing he was too badly injured to escape, they tied him up loosely and left him guarded by two green teenage soldiers. they misjudged him. on his fifth day of captivity, he untied his ropes and escaped. bud stayed on the run for two weeks. he wasn't certain how long he was free. he lost track of time. he made it across the dmz and into south vietnam. a bomb, however, had fallen near him the second night on the run, striking him with should rap nell, and rupturing his eardrums, but limping, bleeding, starving in great pain, bud kept heading south, across rivers, through dense jungles, over hills, crawling sometimes on his hands and knees, evading enemy control and surviving on berries, frogs, and rain water. and on the last night of bud

others escape he arrived within two kilometers of a forward marine base. judging it more dangerous to approach the guarded base at night until and waiting until the morning, bud slept one more night in the jungle. early the next morning he encountered a see -- viet cong patrol, and he was captured and taken back and tortured more. a few days later bud's can'tors took him to the prison we called the plantation, where i would meet him. he was one of the most grievously injured pilots to arrive in hanoi. helped nurse him back to some semblance of health, although we would never fully recover from his wounds. then, bud helped norris nurse me. whenever i felt my spirits and

resistance flag, i looked to bud for the courage to continue and for the example of how to serve my country in difficult circumstances. but was the bravest man i ever knew, and i've known more than a few. he was great company, too. and made it possible to actually have fun in prison once in a while. he received the medal of honor when he came home. the highest of his many decorations for valor. despite his injuries he managed to regain flying status and commanded a flight wing. when bud ultimately retired from the air force, he practiced law, after his service in world war ii, but before he deployed to the korean war, he graduated from college and law school. he devoted his practice defending the interests of his fellow veterans. bud and i stayed close through all the years that have passed since our war. we talked often. we saw each other regularly.

he campaigned with me and advised me always. we argued sometimes, agreed more often, laughed a lot, and always enjoyed each other's company. i'm going to miss him terribly. even though bud had reached advanced years for some reason i could never imagine bud yielding to anything, even, i thought, to the laws of nature. tough old bird that he was, always thought he would outlive us all. but he is gone now, to a heaven i expect he imagined would look like an iowa corn field in early winter, filled with pheasants. i will miss bud every day for the rest of my life, but i will see him again, know i will. i will cut the field with him. and i look forward to it. mr. president -- >> in a few moments, a

discussion of what the new healthcare law is designed to do and how it's being implemented. in about two and a half hours, a hearing on mcc's upcoming spectrum auction, and then army chief of start ray odierno house budget cuts are affecting the military.

>> up next, discussion about what the new healthcare law is designed to do and our it has being implemented. we are partnering with kaiser health news for the program. a series of discussions focusing on health care. this is a little less than two and a half hours. >> focusing the rest of the washington journal this morning on the federal healthcare law and what means to you. we kick it off today with a series with kaiser health news, and we're joined by three senior correspondents who will help guide us through the law. first up we have mary agnes kerry, jay hancock, and both have been guests at this table before, and sarah varney. in the eastern or central time zone you can --

>> remind us, what were the original goals of the law and what was it intended to do? >> to make health insurance more affordable, more accessible and get people more -- more people covered and to make the health insurance cover more than that it current live does. >> what do we know about the effectiveness. >> several new benefits have been added. things like preventive care, looking at screenings for high blood pressure or cholesterol, mammograms for women over 40. those are available now without copays or deductibilities, adult children up to 26 are now on their parents' health insurance plan. no more lifetime limits on coverage, which heaven forbid someone in your home had cancer, there's no lifetime limit on your coverage, and seniors have

seen their cost goes down for medication prescription drugs with the closing of the doughnut hole. so those are up and rung. >> was we look at costs of getting people insured, what do we know? >> there are concerns over time adding benefits will increase the cost but some of the new bids coming in for the exchanges which enrollment starts october 1st, either run by the federal government or the states or partnered with the federal government and states. some of those bids are lower than originally anticipated so the cost picture is emerging. >> these are for people who currently have insurance plans. you mentioned adult children covered up to age 26. closing the medicare doughnut hole is also on the list. how significant is that? >> it is significant because overtime the -- the doughnut hole in medicare prescription drug coverage has left seniors with alet of costs out of their

own pocket until they hate a catastrophic cap. that's going to be fazed down to having seniors cover 25% of theirs costs so the seniors, many of whom are on fixed incomes and don't have large income this has been helple for them. >> and coverage cannot be cancel except in cases like fraud. >> this had been a problem several years ago. i think california was actually a big state where it started. where you would have your coverage, you would file a claim, and then you wouldn't have your coverage anymore. i would be cancelled. if you intentionally lie on your application, that's the fraud element but if you don't do that, something called recessions are no longer recalled. >> what had been happening was you had to -- somebody was getting cancer treatment and then the insurance companies actually had internal departments that were set up to actually find errors in people's

applications. so, you might be getting a very, very high priced cancer treatment. they would go back and look at your records and see you actually had acne when your were 16, or you had your appendix out and failed to note that. that i would say you didn't give us your complete medical picture, even though neither of those things had anything to do with cancer. we had a couple of cases where people in were in the middle of treatment and lost their coverage. so california actually banned that with a state law. southeasterly states as well and it's been part of the affordable care act now. >> jay hancock, we saw news when the obama administration delayed implementing and enforcing large businesses having to insure they're employee. why was that change made? >> it was significant because it was the delay in one of the major pillars of the law, which is the idea you want to get

everybody insured. one pillar is expanding medicaid for poor folks. the other pillar is the individual mandate that everybody over a certain income has to have health insurance. the other pillar is that employers are obligated -- employers over 50 employees are obligated to cover their employees or pay a fine. and the delay was seen as a setback for obamacare by republicans, who keep arguing it's very difficult to implement this law and this is another sign. it was seen as a big source of relief by a lot of employers because one of the things that is going on with this law is -- it was passed in 2010 and supposed to be -- gee, that gives us four year to implement it. but with all the challenges it squeezed the time to implement it. court challenge, and so what's

going on now is the time to get all these new rules out are squeezed. and that is one of the reasons -- the rules kept coming out, rules are still coming out, even as we're sitting here, and employers were trying to figure out how they were going to comply with the law. have to be in compliance starting january 1st. and the administration decided, look, we'll give them a year's break. we can all take a breather and figure out how to do this. >> i was actually at a seminar for employers given by an insurance broker in southern california, and the room was full of employers who were upset about this and there was a list of date biz october 1st you have to -- and every single employee, letting them know what their benefits are going to be, what they can offer and they were worried they would have to update their computer systems because many of the employers i was talking to didn't have commuter systems that could

track to the level they needed to. so, this one man i was talking to, said i now have to buy $100,000 computer system on top of all these added costs to our business. so when i check back with him he was relieved he had more time. >> he has until when? >> next year -- well, this october, they have to send out notice to their employees that they have to buy insurance as of january 1st. he has until next october to open enrollment for his employees. >> we're joined by senior cover. s from kaiser health,. our guests filed stories on the kaiser web site and they can be read in u.s.a. today and washington post and heart on npr. tell us about kaiser health news. >> we're part of the kaiser family foundation known for its health policy research.

all nonpartisan. it's polling and journalism and other programs and as you mentioned our stories do run in partners throughout the country. the editorial independence element means that the newsroom looks and works like all the newsrooms we have all worked in throughout our careers. we decide our stories. we writes them and pitch them to partners throughout the country and it's always important to note that neither the kaiser family foundation nor kaiser health news is affiliated with the insurer kaiser permanent anyone attachment a little confusing. >> judy from illinois. you're on air. >> caller: i love your show. i'm notices right off the bat a lot of employers -- i have been laid off since 2009, and since then, finding fulltime work to almost parttime work in a lot of areas, and i'm thinking employers are really -- i just found work, probably within the last 35 days, and what i'm

finding is a lot of employers are actually trying to avoid you getting fulltime hours, even though the demands of the work is fulltime work. and they're actually going to the point where they're actually writing people up if they're go over their hours trying meet the demand of their customers. is that fair? what can you do to report it? i think employers should do the american thing. if you have fulltime workers -- parttime works doing fulltime work, they should get benefits just the same but they're trying hide under the under 30 hour bare you're they don't have to pay. i think it's unfair and unamerican. i'd like to see if someone can comment on that. >> what report having you down on this topic? >> quite a bit two points to be made here. one is, mam ma'am, if your employer is asking you to work more than 30 hours a week and not paying you, or asking -- not

paying you for any hours you're putting in, that's a reportable -- that is against the law. they're not supposed to do that. it's been known to happen every now and then, and you should talk to your supervisor about it and if you don't get any satisfaction you can talk to the illinois labor department or its equivalent. i don't know the exact name. the other point to be made is the big one, which is you note something that is a bit of a trend going on here, and that is that the number of parttime jobs has been growing, and this has given something of a talking point to republicans because they claim that the growth in parttime jobs and the relative lack of growth in fulltime jobs us -- they blame it on obamacare, and as you mentioned obamacare requires coverage for large employers, for employees over 30 hours a week, and this

is giving incentive employers eo keep employees under 30 hours per week. the delay in employer mandate is giving employers some time to rethink this and maybe they're not going to do this 60, under 30 -- this over 30, under 30 split. the question is, will this continue? some economists blame the growth in parttime jobs just on the recovery from the recession in general. there's something going on with globalization that has to do with it. a lot of republicans are blaming it on the affordable care act, and we're going to be watching the job number in the coming months to see what is going on. >> here's a story that jay hancock filed for kaiser health news. obamacare delves a relief for a family business, and looking att angelo's restaurant, he writes: like businesses across the country, recovering from a

miserable economy, and the bottom line was the color of a special marinara sauce. so the opinioner probably speaks for many when he expressed relief about the decision to delay the affordable care act requirements for employer insurance until 2015. we'll talk more about what this law means for businesses. let's hear more of your call us. jonathan, phoenix, arizona. go ahead. >> caller: i want to comment about the age in which it covers, say your parents will cover you. i believe it was 20 or 26. i don't understand why the age limit is so high. they should be left -- once they turn 18, try to get your own coverage, for your own healthcare and things of that nature, and these kind of things, kind of not allowing kids that are growing up to be accountable for what they want. they assume, oh, i enough with mom, and she is going to take

care of me, and i'm living a good life and i have health care until 26. and so that is really allowing kids to be get up and get their own jobs, get their own economy going, for their own health care. i'm 17 and i grew up with different values and i want to know what you thought about it. you agree or disagree with the fact that age limits is so high to be covered under your parent. >> host: jonathan, do you have a game plan for when you turn 18? do you plan -- assuming you're in school. do you plan to continue youred of indication or get into the work force? >> caller: i plan to get a secondary education. of course might be difficult for me to afford my own health care, but that's just part of life. i'm going to struggle with that and find a way to make my own way and once i can afford my own health care, be happy to pay for it. >> host: take us 0 through what the under 26-year-old cutoff means, why it's significant, and

then we can get to jonathan's comments. >> the reason is that so many young americans were going to college, get out of college, with the economic slowdown, were having difficulties getting a job or finding a job with coverage. so that's why this provision was created. it has helped millions of young americans get coverage but the caller's concerns are ones that have been echoed on capitol hill, this this ad unnecessary expense, these individuals ooh get coverage, and in fact the health law does have special, larger deductionible plans, dined of bare bones coverage, larger deductible for individuals he may find it's a good policy for him when it's time for him to go into the health insurance world. so there will be options for younger folks. they're called the young invincibles and there will be options for them, but if they aren't there this is a backstop to help kids getting out of coverage and need coverage, and many, many parents, as well as

adult children out of college, have been very happy to have it. >> actually a study i did a story oregon that looked at whether or not asking a sort of obvious question, which was, does actually having health insurance protect you from catastrophic financial problems? and of course they found in fact it does. so they looked at a group of researcher from rand in california, and they looked at a number of things that would send you to the hospital, poison, traumatic brain injury, situations where you would not have a choice but go to the hospital and they would say, before the provision was implemented and after, and what they found was something on $147 million was instead of being registered as uncompensated care for the hospitals in fact was now being paid out by insurance companies. so the caller's question, there were for a lot of i think legitimate economic reasons students were graduating who

weren't able to get jobs with health insurance who were left uninsured and when they faced a catastrophic illness would have again to the hospital and then would have been sued for claims or the hospital would have to have uncompensated care. >> republicans push for killing obamacare funding, in the was times. this is gaining support among conserve advertise and republicans, looking at a recent poll by cbs, congress and the affordable care act, 39% of those polled said repeal the affordable care act. 36% said expand or keep it. so, where are things at in terms of the fight over this law? >> it continues. it's loud. it's very intense on both sides. and in the house of representatives we'll have the 40th vote to repeal all or part of the healthcare law. this will focus on the internal

revenue service having any connection with this, and i think republicans see a lot of good things for them in continuing to foot the law despite the fact that the supreme court upheld most of it, despite the fact that democrats kept the senate and kept the white house in the november elections. they feel they being republicans feel that the health law is not good for america north good for jobs north good for individuals or employers, and they are very devoted to defunding it, not only in these stand alone measures but also as we look toward the continuing resolution, the bill that will fund the government beyond september 30 new, funding the dt ceiling, and they ask for defund the law every chance they have. >> our next caller is jonathan in new hampshire. good morning.

>> caller: good morning. good morning. i just had a couple of questions that i have had quite a bit of confusion on with some of the misinformation that has been going on about -- in regards to medicare advantage. what, if any, is that going to be dissolved and in comparison to supplemental medicare? because i guess my confusion is, which of the two are going to continue or both or going to continue? if you can answer that, that would be fantastic. >> medicare advantage reimbursements, what the government is paying, medicare advantage plans to cover seniors, is being reduced over time. but they're trying to equalize what the government pays for beneficiary in try d -- traditional fee for service so the program will remain you. talk about supplemental coverage. that's used most often for

people in traditional fee for service. there's a variety of policies to wrap wind what medicare covers. that stay thursday place so neither program is going away. >> i would add that jonathan, medicare -- a lot of people have been predicting that a decline in medicare advantage coverage because of the funding reductions. we're not seeing that anywhere in the insurance industry. these plans, if anything, are only getting more popular, despite the reimbursement reduction. >> david, new jersey. >> caller: good morning. so been unemployed for two years and uninsured for that same period of time. i have done a little research into -- i gone to the health and human services web site to get a feel for hour the affordable healthcare act was about getting insure, and i don't want to bash the program but seems clandestine.

they don't want to push the numbers or give you an idea how much your monthly premium will be, they talk about the gold, silver, bronze, and platinum package, and it's lard for the consumer to wrap their head around it. i'm going to new jersey blue encloses blue shield and paying the premium they're offering for kind of this basic plan, and i'm only doing that because i don't have a lot of confidence right now that the affordable care act is sharing the information i need. i'm not in the position to really even afford this. i was a relatively high income earner in the last couple years and now i have to take just basic insurance. so, i really have a question. i apologize, it's more of just an observation. i don't know if anything has anything they want to add to that. >> jay hancock. >> a couple thoughts, david. one, yes, it's really

complicated. however, in a few months, if everything works as it's supposed to, we're close to the way it's supposed to, a lot of things will become clearer. new jersey's health exchange and health exchanges are these online market places where everybody like you are supposed to go on and sign up for coverage. if the software is designed right you'll be able to go on there and actually get a really clear idea another of what your choices are, what the tradeoffs are in the plans and what the plans are going to cost. again, those open october 1st. and people like you have until march 31st of next year to sign up for them to get coverage and comply with the mandate. one other quick tip. go online, and google obamacare subsidy calculator. this is something our colleagues at the foundation have put

together. a great tool that will show you what coverage is available in particular what kind of subsidy you will get bases on your knock help pay the premiums. i if your enemployed you will almost certainly qualify for a subsidy. so i'd check that out. should give you a bit more information. >> one question for them would be, jay, should he wait to try to get his plan until october 1st? when he'll actually be able to go into one of the exchanges? >> that's a great question. if you haven't bought plan and signed a contract already, wait until october because that's when the subsidies become available. they're not available now. if you have bought the plan already, you're doing the responsible thing by being insured but you'll get financial help if you wait a little bit. >> the subsidy calculator is from the kaiser family foundation. you can see it here, and it's a

way to plug in information and fine out some results. some tweets coming in on the question of young people and their health insurance. jan says i believe most young people don't want to stay on their parents' insurance if they can find it on their own, and then we see this, from -- a twitter handle -- but saying, under 26-year-olds can learn responsibility by reimbursing their parents for their sharing and it will be cheaper than getting their own insurance, we saw this from don. what kind of adults under 30 get catastrophic include hurt or injury? what does this require 100% of to us get coverage? so people not on their parents' health insurance so take us through the question why hundred% of people have to get people.

>> younger people tend to be healthier and insurance is a balanced risk. so you need the younger, healthier people in the risk pool to balance it out, and to jay's point, looking at subsidies that might be available with not only what your premium is but your copayss and deductible you can get a lot of financial assistance. so it's part of the nature of insurance. this is where the individual mandate comes in. it's also important to know there are lot of young people looking at this, weighing the penalty, which is only $95 and they're think can do i simply pay the penalty or get and get health insurance that is the balance they have to make. you have to remember to the point, if you're not covered and you have some catastrophic event you get a car wreck, twist your knee, something happens to you, you're responsible for the costs if you're not covered. >> if you look at what the penalties will be next year, you

mentioned $95 per person in 2014. or 1% of taxable income. >> whichever is greater. >> why is whichever is greatary significant detail? >> because then it may be a bet -- if you think $95 isn't that a big deal but 1% of your income is higher you might think twice about taking a pass, because they need you. >> george, bronx, new york, go ahead. >> caller: yes. good morning. ladies and gentlemen. i want to -- thank to president obama for what he has done for the nation, but also another thing which is useful for family itself, but i think even being in -- as nation that is respecting what is -- respecting human rights in different part of this world, i want to add that president obama decide what

he has done, done some -- a good result and damaging and putting in jeopardize -- i know that -- >> do you have a specific question about the healthcare law? the federal healthcare law? >> caller: yes. i'm saying that as a human, if you're caring for everybody in this country and this country and the united states of america, we will -- >> host: okay. looking at the federal healthcare law this morning. the guest are three senior correspondents from kaiser health news. and they're answering your questions about the law. we'll turn now to look at the insurance market places a little more specifically, and here are new phone lines.

>> we'll take a couple more calls on the regional lines before we start getting calls in based on whether or not you have insurance. let's hear from donnie in tennessee. >> caller: good morning. how are you? >> host: good morning. >> caller: i work with transportation company. we have about 30 employees and we could easily hire 20 orer 40 but we're not going to simply because of this obamacare and the 50 employee thing. vanderbilt hospital, one of the largest hospitals in america, just laid off 300 people here and the gentleman over there talk can about the reasons that obama didn't go ahead and institute his policies is simply because they're elections coming

up in november for the house-that's pretty much it. and my question for the lady -- i apologize, i didn't get her name -- she said a while ago that people that don't get insurance, if they get hurt, they are going to be responsible for these costs. well, that's fine well and good. if they don't have the money and they're already getting subsidies, they don't care if they're responsible because there's no money to get. so what is going to do, already paying for these people to start with. what this point of changing the system? and i'll hang up and listen. >> grandfather you -- before you hang up, any followup questions for donnie? is his store sound like one you have heard before? >> it's out there. a lot of anecdotes of employers saying they're holding off hiring. i suspect a lot of it is because of the uncertainty surrounding the rollout of the law. i think a lot more will become clear about what is allowed and not allowed and what you can do

after the thing gets up and going but it's going to take a few years for that to happen. >> this question is -- you don't have insurance, just go to the emergency room and somebody will treat you and you can walk away and hands free, and it's absolutely not at all like that. i mean, i met this one man in brownsville, texas, who works fulltime in the shipyard down there, and he is uninsured, 22 years old, he -- a couple years agod a had to go to the hospital for an emergency. they sent him a bill for $11,000. he earns $15,000 a year. i asked him what did you do about the still in he says i still have it. so if he wanted to go and try to buy a house or apply for a loan, that's going to be on his record. so, this idea you can go to the emergency room and walk away it's a fallacy. yes, of course, there's hundreds of millions if not billions of dollars in uncompensated care for sure, but the price to the

individual and to the family and their financial record is not one of just a clean slate. >> john in independence, missouri, good morning. >> good morning. my question is this. to me, this is strictly health care that has to do with big business and money and insurance companies. did enough you see the hour-long special on public television where they compared healthcare costs from this country to other countries in the world? did anybody see that? bus it will open your eyes and makes this look look this is nothing but insurance companies and politicians just greed and money. my brother went to have an mri one or two years ago. $1,300. he told him he had to have a special mr and i come back, it would cost him $2,000. the special, any other country he would have went to would have cost him $91. a doctor's visit in these

countries, you walk in with $15, and you can see a doctor. it doesn't matter what kind of insurance you have. some countries actually have a limit on how much money a doctor can make per year. at the time he hits that limit, then he is working basically pretty much for free. i want to know why it is that this country, with the politics and the insurance companies, who don't seem to care about the elderly or the kids because there's no money no those two groups -- why this country has to have this kind of healthcare deal. >> let's go to sarah for a response. >> it's an accident of history, really, and it's absolutely true that when other countries are looking at -- well, if you ask almost any economist of any stripe, would design the current healthcare system in the united states? and most people would say, no. and many years ago in taiwan was actually facing a situation where they had many uninsured people and went shopping around the world and came to the united

states and they left immediately. the united states healthcare system is not one that is seen as a model by any stretch by any country in the world. but it is an accident in history which is that during world war ii, companies were not allowed to increase salaries for workers, so in order to create into itmentsments into itments to -- enticements to keep workerses they started offering health insurance and it has worked into the healthcare system and has been set up for 405 years. i don't think there's anybody that says this is the perfect system but it has been built on and built on and built on. >> politically its invulnerable. the congress, the democrats said they wanted universal healthcare coverage. this is the political possibility that made it happen, and it's very complex and it is very expensive. one of the things we should mention about the affordable care act is that it is designed

to control some of these cost and reduce just the unaffordability, the sheer expense of these procedures and the number of proceed sures that gets done, showing signs of that happening now. ...

>> let's talk more about the exchanges or the marketplace is. >> it is the new terror and the exchange was the policy wonk term the administration tried to read period as a marketplace because they think that is more descriptive but they are mainly on line based places to go to shop for health coverage. october 1st the day they are supposed to open they have been white finitude to velocity you go through several steps to buy the airplane ticket these will be much more complicated if it will be interesting to see how the design of the

software is to get people the right insurance because it is not obvious. starting october 1st or before october 1st we will start hearing more and more about these exchanges opening and reach out campaign by the federal and state governments sponsoring these exchanges. you will start to hear about navigators' who are consultants that are out there to help size up with a complicated process. the idea is based on this individual mandate, those lacking coverage from their employers will go to the exchange and a sign that they get credited with the

subsidies on the spot and there will be insurance for health care after that. >> host: looking at the time line october 1st is the enrollment and january 1st they begin and we see some states running their own in summer deflecting to the federal government. here is a map from the kaiser family foundation. wise is significant that some states like california and nevada are doing state based but arizona and utah are going to the federal exchange? >> this date that will run its own and then to talk about this even with the state based you see different kinds of models.

said uc active purchases so when the legislature passed it to set it up they authorized those to run the exchange can negotiate directly. it was like a party. there were 100 people there if you thought you were going to an art show. they threw up the rates on the screen and they're very proud of the fact they could get several dozen insurance is to participate in they think they selected 13 in the rates were much lower than what people anticipated i think we're seeing that now where the rates are coming in low were but california is an active purchaser where other states

say we put it in the marketplace as anybody can sell their wares. >> host: what are the states having a harder time to get them marketing their products? >> mississippi there would be none for those that live in the delta and other places but this is what you get with the marketplace. you have to have customers willing to buy a product and if you are a company to look at the delta of or wyoming was only half a million people in the entire state that is not a market i want to go into. as long as we have health insurance delivered to private companies than that is what you will get.

>> host: this story was recently filed the mississippi consumers may not be offered insurance subsidies. >> mississippi when we wrote the story there were some blank spots on the map and subject of great consternation. >> host: what does that mean? >> if you were eligible for health care and subsidies to buy these exchanges is surging counties in mississippi you had no choice. i qualify i of eligible y 12 by the exchange, you sign up and nobody would offer in your part of the world. since then hhs in washington as well as the mississippi

insurance commissioner is working really hard to arm twist some insurance companies to get in there and he amanda -- he mieno one of the larger and also owns a chain of hospitals and agrees to offer a plan where there may not have been any choice before that. there are other states california will have 13 that is even after they had to turn some people away. other states south dakota, iowa, they will not have any empty counties but the choices could be thinner than those that are aggressive like maryland. >> host: battle health care is local.

in california this state is broken up into different regions so they have to look at providers and provide a network fare very local and regional sorry regional hospital chain that will look very difficult thing and maybe where there is only one public a hospital. they will have a completely different network up their. so with their ability to offer the insurance package we see those providers in those global areas. >> can you comment will there be sufficient competition? >> let's hear from our caller from north carolina and is insured.

>> caller: i am so glad you are there today. i taught for years in new jersey in your both covered by blue cross blue shield. i had to go out on the stand could not finish return and -- my term but i had a stroke i lost my insurance but was still covered under his but when he passed away they informed me know my insurance is not under free under his i have to pay but every year my premiums are more and more now is $1,200 taken out of my pension check. i have to have it so it doesn't matter if i heard obama say something if you

are injured and he paid premiums you will get many back this year or something to that effect? i don't want to upset blue cross or blue shield in case they will not insure me anymore but could you the answer that for me? >> i very sorry for the loss of your husband having to deal with those insurance issues but what the president is talking about the health care law requires insurers to spend 80 percent of the premium dollar on health care benefits not administrative costs like the salary of the ceo. he is really referring to those who buy their own health insurance in the individual market they could get it checked back if they

meet that 20 rule but if your employer buys it for you, then your employer gets the money back and you don't see the check and that is confusing. i would encourage you to look at the exchange's i thank you said north carolina. to find out what subsidy might qualify for but also your copays and deductibles you are retired with a pension you should take a look at that to see if you king get a better deal. >> a comment from our facebook page. >> of those young and hater -- healthy male and what health insurance and should not have to pay a fine and a story. we are looking at your comments and questions on your facebook page.

let's let's get the numbers of what you will pay. $95 and then it goes up from there we see that amount rise and then to% of taxable income than it goes up in demote one dash even more 2016 then it is a newly adjusted for the cost of living so how does the government keep track of this? will they kiam -- come knocking on your door or when it is tax time? >> i think they will track through the irs then they will take other steps to collect that money. >> you should know if you don't pay it is not a criminal offense.

no jail time you cannot be prosecuted. but they can come with the worst that can happen is they can garnish your paycheck in the future if you owe the penalty but it will be interesting to see how much information the irs has to enforce. it has a huge role not only charged with enforcing it but they verify your income that you are eligible so they will have a lot of information but that enforcement aspect is one that nobody is concentrating on now in the white house doesn't want them to. >> with this tax preparation companies are very interested to say we will make this part of the process and those people are

not high income at all. working-class family in the idea we will help you figure out what the subsidy will be or how to apply that proactively to have a lower premium. so the people are looking there will be asked to talk about the health insurance with their tax preparers. >> host: we have a and uninsured caller. >> caller: i have been doing zero lot of taking care by softer natural means they're looking for doctors but people call about health care the main reason insurance companies like that but i would love to see i wish people would stop calling it obamacare but we

need to have people stop listening to fox cable they have health care. we actually need health care. i don't want to go to the doctor and sit for an hour naked for two minutes of time if that cost me $150.10 goes to actual health care. can we ever come to a time when we will actually have no employers responsible for health care or health insurance? people should but have their own health care. >> there is interest among republicans and those that say health insurance should be something of you have is affordable the you take with you. that bob is out there that is not within space does it is very much based on the

employer system but would that surprise me if several years down the road you see that disconnecting from employment but it will not reduce your weight waiting for your physician but you will have more preventative care coverage. we all call of the explanation of benefits which is charged and what you have to pay that will be worth watching for you by your frustrations of getting your own health care are shared by a lot of people. >> using the word the affordable care act or obamacare. >> it is significant because words carry meanings and hidden meanings and obamacare is a pejorative

term dreamed up by its opponents and used as obamacare the terrible complicated law. last year i don't remember precisely the administration started to embrace the term as a brand. >> host: the president said i do care. [laughter] >> and for those that try to promote the of lobby sought public ad campaigns and there is examples of benefits but now it is shorthand it is a lot easier of the affordable care act of 2010 and i think that is what we see now but if journalists will sides are using it and we tend to

throw out there. >> will it be the affordable care act in reduce the cost of health care? the presidency you can keep your health insurance policy that is not true if because now employers make those decisions so there is pro and con at the same time. >> we'll now going to a health care provider. >> i use them for their cat consider almost on a daily basis but i have a bone to pick with j.d. wait until october 1st? the risk pool will increase may be about a hundred 25% -- when a 20 representative

55 years old you will not get that to the end of the year you have to cut that for every month then wait for your tax return so that is a problem. >> is a problem depending on your income from a caller in new jersey it does make sense to wait because he is eligible for the subsidies and they will be available if you're not eligible for the subsidies, then we should say right now while talking about the subsidy subsidy, and they are available for a family of four if you haven't come $94,000 in change is you could have a substantial middle-class income to still be in eligible for the tax credits for a single person is about 46,000 and change

so you could go on to the exchange to get the tax credits applied for the sticker prices that you read about a, depending on your income is not what you pay in the end but your point is a good one if you're over those limits if you are a family making $100,000 per year with no health coverage then you may want to talk to a broker or another source now to look at a plan because in some cases that situation may change in october it would be a better deal to lock that in now. >> host: failed arizona with another medicaid recipients. >> caller: good morning. i have quite a bit of concern of the republican

people i guess i call them people, of the diminished government ryan for a strong government so we can be governed and accountable. the people that corrupt the system in their kin be held liable and criminally charged. but the republicans keep hollering about too much government and we need to enforce the laws that are there such as health care, epa trying to be good citizens. >> host: how will this health care law impact your coverage? >> somebody should be answered me because they already have health care through medicare but my wife was in the hospital freer

four years ago and i have got bills and she was in the hospital twice just overnight they were bills over 35,000. i paid them even though we had medicare and eligible. here is another case where i took her to the hospital i griped over the cost what i would have to be injected with a little bit of juice. she was in there about three hours total. i did not get a bill i was being billed $1,400 i should of been the office and they said okay and they told me

we will put it down a $866. >> what about negotiating? >> i am a little concerned about that bill if you are on medicare 305,000? if i got a bill like that i would call my insurance company and ask right away as a cautionary note we're talking bell something the explanation of benefits the paper that comes in the mail to explain the charges in but you have to pay you should question that before you pay the bill if you think it is too high. >> host: we are seeing some questions come in on twitter. >> if the average person needs step-by-step instructions they just make

it to general and confusing. >> that is what is supposed to happen with the exchanges' open in october. it might help to explain a little bit in more detail what you are likely to see when you go on-line to buy health care through the local exchange your marketplace. first of all, each state will have a different name in maryland is the maryland health act in california cover california. every state will have a completely different name of the publicity is only just 30 you will see the ad campaigns even if you don't know the name go online to gruel rhode island obamacare name it will come up their web sites looking like said travel web sites to book

hotels and airplanes and you will do several things and again this offer is designed intelligently to walkie throw. you need to verify your income there should be linked with the irs records putting your social security number to say you earned x last year you are eligible for this amount of subsidies into one the advance notice go to the kaiser family foundation subsidy cow consider it you will see that. once you qualify you will shop for the insurance company you'll see all the different choices the software that is good will help you choose and ask

priorities is it important to keep your career dr.? menu will tell them your doctor they will steer you to the plan of your doctor or what is more important? the lowest premium possible you may not be able to keep your doctor because a lot of these plans sold to save cost they set up a narrow network that is a relatively skinny group of doctors and hospitals available but in return for that narrow access, the cost is down. in return for a higher volume of patients will you cut the cost? that is passed down that is

a big way hell competition is working to give the best deal. one thing we have not talked about is you hear a lot about sticker price for the of plan we did one from a maryland in the typical sticker price for the lowest benefit the bronze plates and they will have bronze bronze, silver, gold, platin um depending on the level of benefits. the bronze plan will have low premiums if but a relatively high number of copays and deductibles. one of the things you need to do is not just pay

attention to the sticker price typically will be in the 200 or $300 range in some states it is less sounds pretty good. what the exchange needs to focus on is looking at your out-of-pocket cost particularly if you have medical issues for a chronic condition you need to figure out the total cost for the year and a good exchange software ought to assure you that. i have test driven some of the programs that is what the good ones do to show udf from price but the total cost of the plan. >> does the federal site direct you to your state

exchange? >> they should if there on the politician had been. health care .gov is the site you can go now to see what premiums are costing now. >> you mentioned the a lot of pocket and a coke pay i think they can be as high about 12,000 for families so you really have to figure out how much my expected to pay out of pocket? there is that balance. >> host: we do have gas from kaiser family help in answering your questions. now looking at the federal health care law and would it means to you we have three correspondents here we're joined by mary agnes carey and t. levin and sarah varney right now basing your

job we will look now what it means for the workplace. let's start with a call from minneapolis who is an employee's. >> caller: thank you for taking my call. i have been working since the age of 15 and i will be 65 on friday. in 2008 i started to get social security disability and i also have a subsidized insurance through the state. it has been great for me hyoscine the same doctors i have had 15 years including some specialists but i have

to work. if i don't make $60 a month which is not much and i plan to do that's to have the supplemental but when school is out that i am in limbo about my insurance coverage through the state because of the kind of plan that i am on if i am not working then i have the spin dash out of $1,000 -- thus been down of $1,000 and i cannot afford that. i wonder if the affordable care act will help me in any way so that if i am not working like is still have coverage to the state.

>> my first thought is either go to medicare .gov to find out how medicare could think up with the current coverage that you have if you will be 65 on friday so that is my first thought for you and also the providers you are currently using i know your program well if it works of medicare that is what i would abies you to dufay -- advise you to do. >> caller: good morning. thank you for taking my call. number one, will the exchanges the offering dental and vision? and never to my husband is on medicare he is on part b

if i could get dental and vision care for him spinnaker you getting insurance now for yourself out of pocket? >> caller: yes i am. i am part of these self-employed play and through the state of arkansas i pay a premium every month of $35 that gives me six visits to any doctor in the network and i also pay 15 percent of the total to the doctor it has been quite affordable for be right now and that program will end on december 31st.

supply will be shopping in the marketplace when they are set off october 1. >> that is a great question i don't know if dental and vision will be in the exchange. >> only pediatric dental it and i believe vision not to get glasses that may be a medical record issue but not vision coverage of don't think that will be that way with the exchanges but it sounds like that could be a good option for the caller. >> i know california is going to the pediatric dental plan right now. >> interesting about dental

it can be offered in the medical coverage or stand alone and that is how most of us getting in is that is the case to buy that for your child you have separate copays come a separate deductibles taiz a problem with some democrats on capitol hill so it is something we're watching during the implementation. >> host: if you are self-employed or very small business how to approach the law? >> a one-person shop? i forget i'm a business and go shopping as a consumer. that is where the subsidies are likely to be the best or the most options. to products are on the exchanges for individuals and families the other is

for small businesses. vendor 50 employees could buy coverage for their workers it is taking a little bit of time to get ramped up the idea was like i want a car repair have 25 workers the vision was i could sign upon the exchange mineworkers' could shop in the same way individuals will shop to go through these traces that is not going to happen that is several pieces of the law that proved too complicated

to get up and going. small business will be in business but karoly likely be one choice for the employees to offer coverage the contract with one insurance company. >> i do see the plan to raise element has been delayed in their only have one play an option and in 2015 there is more of the choice element. >> that is the idea again is supposed to be about competition and diversity if everything goes as planned if you are the employee you allow traces better somewhat similar to the individual.

>> right now you are a small business that is your pool where with the other exchanges they have everybody you pool resources to have a better bargaining power they can offer a better deal because the pools are there. >> the kid's summer camp for the average age is 23 will not pay the same the similar premium as the employer of the old river forces higher coverage. >> host: cleveland ohio go-ahead. >> caller: we have 23 employees and devil rays

provided benefits in the b.c. years we split 75% / 25% now as of jan refers to -- jay refers to there will be taxes on the policy $0.18 per person insured plus the reinsurance fee plus a 2 percent of your premium and we figured it out for a family of four that is $59 per month in the federal fees so we switched to the marketplace will they have to pay these fees as well or is that just private insurance to pay the fees and? >> the fees will be on all

insurance products with the exception of self insurance we have not talked about this and it is traditionally been the practice of very large companies basically when the employer is big enough with enough revenue it can agree to pay the medical bills directly intake samba risk and often buys reinsurance but the basic idea is your employer pays the bill with direct contracts to pay the claims then the employer writes the check but now even employers are looking at self insurance because these taxes are not levied because

that is a licensed insurance product where the rubber hits the road. businesses self insuring to get the reassurance from the insurance broker's. so for example, of yourself and shirred you could buy reinsurance with any single employee of yours fit is more than $10,000 you would not be liable and looks like insurance to you in your employee you are exempt from the required health benefits it is controversial because

it shrinks that risk pool that we were just talking about to let anybody share expenses it is a concerned of the atomic administration but for a firm like yours it could be an option i would talk to your broker to see what he has to say. >> host: what does the federal health care lot change for those who do have private insurance? questions about that? >> you have more preventive care with no copiague or deductible i do not have copays that i did before with the screening for

mammography or blood pressure or cholesterol maybe that will change for you if your have an adult child up to the age of 26 you can put them on your health insurance policy and there is no lifetime limits for adults you cannot be discriminated with pre-existing so the thought not only helping those that don't have coverage but helping those said to have coverage but limited benefits but what does that do to the price? >> we should mention people who already have coverage with employers is that employers and insurance companies are making changes in their coverage independent of the affordable care act.

the hallmark is consumer directed health plans are the high deductible health plan. i suspect a lot of people are seeing this that your employers are asking you to pay higher deductibles $1,002,000 when you seek care in the a.d. it is not only to save the employer money that the philosophical idea that now that more of the responsibility for payment is on your shoulders that's should turn you into a savvy shopper to compare prices and call with the expensive procedure and what will you charge me? but the problem is the

transparency of medical prices isn't what it is prepared to doctor says you need the colonoscopy or the mri if you have a bad back the prices berry hugely and if the insurance company is asking you to shop around but with the cost sharing too much larger degree with employers of all sizes and they're typically used by small businesses because they were cheaper. now even the very largest employees have high a deductible plans or health savings